Provider Demographics
NPI:1871967786
Name:SPEIGHTS, KENNETH (MASTER DEGREE IN PSY)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:SPEIGHTS
Suffix:
Gender:M
Credentials:MASTER DEGREE IN PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16331 SE PEACH ST
Mailing Address - Street 2:
Mailing Address - City:BLOUNTSTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32424-2211
Mailing Address - Country:US
Mailing Address - Phone:850-237-1759
Mailing Address - Fax:
Practice Address - Street 1:20311 CENTRAL AVE W
Practice Address - Street 2:
Practice Address - City:BLOUNTSTOWN
Practice Address - State:FL
Practice Address - Zip Code:32424-1947
Practice Address - Country:US
Practice Address - Phone:850-674-8888
Practice Address - Fax:850-237-1223
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-17
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18184101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health